LONG-TERM EFFECT OF NADOLOL OR NADOLOL PLUS ISOSORBIDE-5-MONONITRATE ON RENAL-FUNCTION AND ASCITES FORMATION IN PATIENTS WITH CIRRHOSIS

The association beta-blockers plus nitrates has been reported to impai r renal function and renal sodium handling, leading to increased risk of development of ascites, or worsening of a preexisting ascites, or i ncrease in the requirements of diuretic agents. In 81 patients with ci rrhosis and esophageal varices, participating in a multicenter control led clinical trial of prophylaxis of variceal bleeding comparing nadol ol (NAD) plus isosorbide-5-mononitrate (I5M) with NAD alone, renal fun ction, presence of ascites, and diuretic requirements were assessed at inclusion and after 6 months of follow-up. No significant variation i n s-urea or s-creatinine was observed in either group, Three patients in the nadolol group and two in the NAD plus I5M developed ascites at 6 months (P =.70), and a need to increase diuretic regimen was observe d in four and three patients, respectively (P =.76). Decrease in heart rate and in mean arterial pressure was similar in the two groups. The re was a significant correlation between increase in s-creatinine and decrease in mean arterial pressure in the whole series (P =.015). Only in patients treated with the association was there a significant larg er proportion of patients ascitic who became anascitic, than of patien ts anascitic who became ascitic (P =.03). In patients treated with the association, there was a significantly larger decrease in hepatic ven ous pressure gradient (P =.05). It is concluded that patients treated with the association NAD plus I5M are not at increased risk of develop ing renal dysfunction or worsening of ascites compared with patients t reated with NAD alone. Therefore, the presence of ascites should not b e considered a contraindication to the use of this association in pati ents with cirrhosis and portal hypertension.